University of Twente, Department of Health Technology and Services Research, P.O. Box 217, 7500 AE Enschede, The Netherlands.
Oncologist. 2012;17(12):1581-93. doi: 10.1634/theoncologist.2012-0151. Epub 2012 Sep 14.
Many cancer survivors suffer from a combination of disease- and treatment-related morbidities and complaints after primary treatment. There is a growing evidence base for the effectiveness of monodimensional rehabilitation interventions; in practice, however, patients often participate in multidimensional programs. This study systematically reviews evidence regarding effectiveness of multidimensional rehabilitation programs for cancer survivors and cost-effectiveness of cancer rehabilitation in general.
The published literature was systematically reviewed. Data were extracted using standardized forms and were summarized narratively.
Sixteen effectiveness and six cost-effectiveness studies were included. Multidimensional rehabilitation programs were found to be effective, but not more effective than monodimensional interventions, and not on all outcome measures. Effect sizes for quality of life were in the range of -0.12 (95% confidence interval [CI], -0.45-0.20) to 0.98 (95% CI, 0.69-1.29). Incremental cost-effectiveness ratios ranged from -€16,976, indicating cost savings, to €11,057 per quality-adjusted life year.
The evidence for multidimensional interventions and the economic impact of rehabilitation studies is scarce and dominated by breast cancer studies. Studies published so far report statistically significant benefits for multidimensional interventions over usual care, most notably for the outcomes fatigue and physical functioning. An additional benefit of multidimensional over monodimensional rehabilitation was not found, but this was also sparsely reported on. Available economic evaluations assessed very different rehabilitation interventions. Yet, despite low comparability, all showed favorable cost-effectiveness ratios. Future studies should focus their designs on the comparative effectiveness and cost-effectiveness of multidimensional programs.
许多癌症幸存者在完成主要治疗后会遭受疾病和治疗相关的多种并发症和不适。单维度康复干预措施的有效性已得到越来越多的证据支持；然而，在实践中，患者通常会参与多维方案。本研究系统地回顾了癌症康复的多维康复方案的有效性和一般成本效益的证据。
系统地回顾了已发表的文献。使用标准化表格提取数据，并进行叙述性总结。
纳入了 16 项有效性研究和 6 项成本效益研究。多维康复方案被发现是有效的，但并不比单维度干预更有效，也不是所有的结果指标都有效。生活质量的效应大小在 -0.12（95%置信区间[CI]，-0.45-0.20）至 0.98（95%CI，0.69-1.29）之间。增量成本效益比范围从 -16976 欧元（表示成本节约）到 11057 欧元/质量调整生命年。
多维干预措施的证据和康复研究的经济影响是稀缺的，并且主要由乳腺癌研究主导。迄今为止发表的研究报告表明，多维干预措施相对于常规护理具有统计学上的显著益处，尤其是在疲劳和身体功能方面。没有发现多维康复比单维康复有额外的益处，但这也很少被报道。可用的经济评估评估了非常不同的康复干预措施。然而，尽管可比性较低，但所有评估都显示出有利的成本效益比。未来的研究应将其设计重点放在多维方案的比较有效性和成本效益上。
